HIV/AIDS & poverty: underlying cause of the humanitarian crisis in southern Africa
- More than half of the at-risk 14 million people are children
- Growing number of child-headed households
- Some three-quarters of funding needs remain unmet
1. EMERGENCY OVERVIEW
HIV/AIDS exacerbates the southern African crisis
Southern Africa is the scene of a complex humanitarian crisis exacerbated by catastrophic levels of HIV/AIDS, extreme and deepening poverty, drought, and a general economic turndown in the region. About 25 per cent of the productive age group (15-49) in the region is living with HIV/AIDS, with Zimbabwe registering an HIV infection rate of 33.7 per cent.
One of the most visible manifestations of this crisis is severe food shortages, felt most acutely in Zimbabwe, Malawi, Zambia, Mozambique, Lesotho and Swaziland. But UNICEF monitoring in countries like Malawi show high levels of stunting in children, a sign of chronic, long-term malnutrition. This implies that communities have been struggling with extreme circumstances for years. In some countries, government policies have aggravated the situation.
The UN estimates that more than 14 million people in the six southern African countries are vulnerable to a host of risks including famine, disease outbreaks, spiraling poverty, exploitation, and deteriorating social services. WFP has mounted a massive relief operation to meet a 4 MT food deficit in the region whilst UNICEF and other UN agencies are addressing other areas, including food insecurity as well as the underlying HIV/AIDS crisis.
More than half of the 14 million people at risk are children. Already 4 million children across southern Africa have been orphaned, largely as a result of HIV/AIDS. They are forming a growing class of child-headed households. Zambia has one of the highest rates of orphaned children in the world with 13 per cent of children having lost one or both parents, mainly to AIDS.
HIV/AIDS and food insecurity are closely related
As people become increasingly desperate for food and other basic resources, they may engage in high-risk behaviour such as prostitution or migration that leaves them exposed to HIV infection. For people living with HIV/AIDS, food shortages compromise their immune systems; they succumb to secondary infections, which increases the costs of care-giving. The rising costs of care-giving means less money for food and education. In these circumstances, children are obliged to look after sick parents, drop out of school or turn to the streets for survival where they are more vulnerable to exploitation and other forms of abuse. As food insecurity deepens, coping mechanisms are coming close to exhaustion and people are resorting to extreme measures to survive. In Zimbabwe some families in rural areas are reported to be marrying off their young daughters in exchange for bags of grain.
Historically pandemic diseases have brought about major social, economic and political transformations in their wake. In the worse-hit countries in the region, the HIV/AIDS epidemic is likely to have far-reaching effects on governance, national economies and social structures.
2. UNICEF RESPONSE AND PLANNED ACTIVITIES
UNICEF refines its sub-regional response to the crisis
UNICEF held a high-level internal meeting on 3 October 2002 in Johannesburg to further refine and consolidate a common sub-regional approach to the current crisis in southern Africa. This is particularly important in the light of improved UN inter-agency coordination taking place in the Regional Inter-Agency Coordination Support Office (RIACSO) in Johannesburg. UNICEF has been part of this structure since September 2002.
UNICEF agrees with partners that the food deficit in the six southern African countries is the immediate and most visible manifestation of an existing crisis caused by HIV/AIDS and extreme poverty. In this context, sustainable results at alleviating the crisis cannot be achieved without addressing the issues related to the HIV/AIDS pandemic.
Senior UNICEF staff attended the one-day meeting from the Regional Office for Eastern and Southern Africa in Nairobi, Geneva Regional Office and Johannesburg coordination unit. UNICEF Representatives and programme officers from Zambia, Mozambique, Malawi, Swaziland, Lesotho and Zimbabwe attended the meeting as well.
Each UNICEF country office made a presentation on how it has been implementing a sub-regional response to the southern African emergency. The response consists of a minimum package of 11 core activities to be implemented immediately and as a priority in all six countries. The package draws upon ongoing activities within the regular country programmes and does not restrict UNICEF offices in the various countries to undertake additional and relevant interventions. These programmes target the most vulnerable children, namely, child-headed households, orphans, school dropouts and child victims of abuse and exploitation. Implementation progress of the core and other activities related to the current crisis is reported below.
Identifying and advocating for orphans and child-headed households for the provision of assistance
Child-headed households are a growing phenomenon in the context of the southern African crisis. UNICEF deems it a top priority to identify and register orphans and child-headed households so that they can be more ‘visible’ to receive humanitarian assistance. UNICEF offices in Mozambique, Lesotho and Swaziland have all carried out assessments on child-headed households in conjunction with government and other partners. UNICEF Mozambique reports relatively small numbers of child-headed and elderly-headed households in the 10 surveyed districts most affected by drought and HIV/AIDS. Further assessments are being carried out to determine the numbers of orphans and women-headed households. In Zambia, three out of 72 districts have been identified as having the largest concentration of orphans. Five thousand kits of basic utensils have been ordered for distribution to child-headed households in the three districts. In Swaziland, community surveys have shown that children run 10 per cent of all households. NGO partners are currently gathering more detailed information on child-headed households in the two regions that are affected by the drought to establish a beneficiary list for food distribution. The government and NGOs have agreed that priority assistance should be given to orphans, child-headed households, children caring for the sick at home, children dropped out of school and sexually abused children. In Lesotho, an additional concern is abandoned babies. UNICEF and the Social Welfare Department are doing a rapid assessment on this phenomenon in four district hospitals to investigate the reasons behind infant abandonment and devise an appropriate response.
Measles immunisation and Vitamin A administration
Measles immunisation and vitamin A administration for children are vital to prevent possible measles epidemics and other disease outbreaks when children’s immunity is compromised by malnutrition and HIV infection. Malawi, Zambia, Zimbabwe and Swaziland have already carried out routine measles immunisation in 2002 but coverage rates vary within countries and need to be above 90 per cent to stop an epidemic from breaking out. In Zambia, there are currently three major outbreaks for which data is available - two in refugee camps in the Western and Northwestern Province and a third in the Central Province (Kapiri Mposhi). Cases are occurring predominantly in older children above the age of 15. In the Central Province, the outbreak has occurred despite routine coverage rates of over 80 per cent for children under 5 years of age. The Government of Zambia has officially requested assistance to control the measles outbreaks and UNICEF and WHO are mobilising funds to conduct emergency vaccination. In other countries such as Swaziland mop-up campaigns are planned to start from October, and in Mozambique where only one out of 142 districts has a ‘protective’ measles immunisation rate of over 95 per cent, a government policy decision still needs to be taken whether to conduct a mass measles campaign across the whole country. UNICEF is urging the Mozambican Ministry of Health to do so. In Lesotho, UNICEF and WHO advocacy efforts with the government have paid off when the Minister of Health agreed to a measles campaign for the end of the year.
Vitamin A is generally administered during measles vaccination campaigns. This has been done in Malawi, Zambia, Zimbabwe and Swaziland. While in Mozambique, vitamin A tablets are being distributed as part of the supplementary feeding programme run by UNICEF, WFP and NGO partners in 60 schools in both drought and unaffected areas of the country. In Lesotho, vitamin A capsules have been ordered to complement the upcoming measles campaign.
Intestinal worms are commonly seen in school-age children and cause iron deficiency anemia (IDA). IDA in children is strongly associated with decreased physical and mental development and impaired immune function. Multiple studies have shown the benefits of treatment of IDA among pre-school and school age children through regular de-worming. Benefits include lower absenteeism and higher scores on tests of cognition or school achievement. The cost is around US$ 1 per child each year.
In the context of the southern African crisis where a multitude of conditions including malnutrition and HIV/AIDS are having an adverse impact on children’s health, regular de-worming is critical to keep children as healthy as possible. Although de-worming through health clinics is part of UNICEF’s regular programme in Swaziland, a school de-worming project is being developed to begin this month in conjunction with a school feeding programme. School de-worming initiative will then be repeated at the start of the new school year in January 2003 and conducted on a regular basis in up to 80 per cent of schools in emergency areas. In Lesotho, de-worming tablets are being procured and in Mozambique, de-worming activities will be conducted in conjunction with the school feeding programme.
Since 2000, cholera outbreaks have been on the increase in Southern Africa Development Community member states, in particular, Malawi, Mozambique, Zambia, Swaziland, Zimbabwe, Tanzania and South Africa. Where previous epidemics occurred every four to five years, cholera now befalls some countries every second year or annually. This is indicative of the disease becoming endemic in those countries.
With the upcoming rainy season in Zimbabwe, UNICEF, WHO, and the Ministry of Health and Child Welfare have decided to rapidly identify the districts most at danger to cholera epidemics and organize health awareness campaigns. This is following an outbreak of cholera in Masvingo province in September. Training of health workers and community mobilisers will be included in the response activities as will water and sanitation interventions. WHO is procuring oral rehydration salts (ORS) as part of this effort. In Swaziland, UNICEF is procuring 100,000 sachets ORS which will be pre-positioned in local health clinics in high-risk drought areas. In Malawi, five new suspected cholera cases have been reported in Nkhotakota and Ntchisis districts. While available cholera control supplies are being pre-positioned in the most prone areas, UNICEF has ordered additional supplies including 250,000 sachets of ORS, 20,000 bags of Ringers Lactate, 55,000 intra-venous sets and 26 tents. Training sessions for heath workers on cholera case management are also being developed in collaboration with WHO.
Although HIV/AIDS awareness and education has been an integral part of most regular country programmes in the six affected countries, such activities are being intensified as a result of the current crisis. In Malawi, following discussion with WFP, an HIV/AIDS awareness campaign will be run in food distribution centres. UNICEF has ordered equipment such as megaphones and radio cassette players for this purpose. UNICEF is also looking for additional funding to establish voluntary HIV/AIDS counseling and testing services in the ten most- affected districts, to run from health clinics and nutrition rehabilitation centres. In Zimbabwe, UNICEF and other UN agencies are looking to expand a UN-wide HIV/AIDS initiative currently in place in six districts - two of which are amongst the poorest and most-affected by the drought. In Mozambique, UNICEF is working to build upon its ongoing HIV/AIDS interventions to increase access to voluntary counseling and testing, promotion of condoms and treatment of sexually transmitted illnesses. In Swaziland, UNICEF has developed a new communication strategy on HIV/AIDS that has a special focus on the role of sexual abuse as ‘petrol on the fire’ of the epidemic. An NGO-implemented campaign to change the climate of opinion about sexual abuse among the police, prosecutors, government personnel, religious leaders, and chiefs has been underway since February 2002. Life-skills education in schools, supported by UNICEF, has also had a strong HIV/AIDS awareness component.
Keeping children in school
Throughout the southern African region, empirical evidence shows that children are dropping out of school as the current crisis slices away people’s coping strategies. To keep children to their desks and make schools safe and healthy, UNICEF is targeting schools in the drought- affected areas in each country with a number of interventions including school gardens, rehabilitation of latrines and water supply sources, provision of learning and teaching material, and advocacy. Surveys are also underway in some countries to assess school attendance in the context of the crisis. In Malawi, Zimbabwe, Mozambique and Lesotho, UNICEF is providing school and pupil kits to ease the financial costs of schooling for parents and care-givers. Evidence is also gathering that in drought-affected communities, most children go to school hungry or drop out because of hunger. To prevent this, initiatives to launch school gardens are taking shape in Swaziland with four pilot programmes underway. In countries where WFP is running school feeding programmes such as Mozambique, UNICEF is reinforcing these schools through complementary support such as vitamin A administration, de-worming, rehabilitation of latrines and water supply, and provision of educational supplies. Improving school sanitation and water, especially in drought-affected areas, is also a priority in Swaziland, Lesotho and Zambia. On the advocacy side, UNICEF in Swaziland is urging the government to address the issue of school fees for orphans and child-headed households. A multi-sectoral assessment has recently shown that over 10 per cent of children are dropping out of school in the first term as families use school feeds to pay for increasingly expensive staple foods.
To mitigate against the deteriorating food insecurity in all the six drought-affected countries, UNICEF is supporting supplementary feeding for children and women, and where required, therapeutic feeding for severely malnourished children. The beneficiaries for supplementary feeding include 40,000 children and pregnant and lactating women in Malawi, 50,000 children and their caregivers in Zambia, and 50,000 children in Zimbabwe. UNICEF-supported therapeutic feeding is currently underway in Malawi, targeting between 4,000 and 6,000 severely malnourished children on a monthly basis. In other countries UNICEF is working with government counterparts and qualified NGOs to start therapeutic feeding. In Zimbabwe, UNICEF has ordered therapeutic food (F75 and F100) for 2,700 children. However, some 46,000 severely malnourished children are in need of therapeutic feeding but UNICEF does not have enough funding to cover these urgent needs. In Mozambique, UNICEF continues to support existing therapeutic feeding centres on a small scale. In Zambia, UNICEF is part of an emergency nutrition task force planning to establish 37 feeding centres in health clinics in the most critical areas of the country.
Preventing sexual gender-based violence
The first training phase of the Prevention of Sexual Gender-Based Violence initiative, supported by UNICEF, WFP and Save the Children Fund-UK, has been completed. Personnel from governments, NGOs, UN agencies, security forces and transport associations participated in country-level training workshops. These preparatory workshops focused mainly on raising awareness on the issue and introducing training materials developed under UNICEF leadership. The second phase, involving a cascading Training of Trainers (TOT) approach, will be launched in Johannesburg during the last week of October. A core group of master trainers will be trained to carry out TOT in each of the six countries.
Another priority for UNICEF is to monitor the evolving crisis through its impact on children’s nutritional status and school attendance. Nutritional assessments have been completed in all six countries except Swaziland where a survey is planned for November 2002. The results will be integrated into the second round of Vulnerability Assessments Committee (VAC) surveys taking place across the region in November. Assessments to monitor school attendance and drop-out rates are ongoing in Malawi and Swaziland.
Malaria is a major killer in Zambia with an estimated three million people falling ill at least once every year. People weakened by malnutrition are also more likely to succumb to the disease. Two main concerns have been identified for the coming months-vector control and case management. UNICEF and the Zambian Ministry of Health are working on strategies to accelerate interventions in these two critical areas. In Malawi where malaria also finds a breeding ground in children and adults weakened through hunger and HIV/AIDS, UNICEF is supporting an emergency malaria control programme. This involves distributing 100,000 bed nets impregnated with insecticide to maternity wards, pediatric wards and nutritional rehabilitation centres. Another 1.2 million bed nets have been ordered.
3. APPEAL REQUIREMENTS AND RECEIPTS
In response to the humanitarian crisis in southern Africa, UNICEF, together with other UN agencies, presented its funding requirements to the donor community on 18 July. As part of this framework, UNICEF requested US$ 26.8 million to provide humanitarian assistance to the affected children and women in the six affected countries. Of the appealed amount, UNICEF has received US$ 7.1 million to date, leaving a funding gap of US$ 19.7 million or 74 per cent of the total resource needs. In light of the severe funding shortfall, UNICEF has borrowed US$ 5.4 million from the Central Emergency Revolving Funds (CERF) of the Office for the Coordination of Humanitarian Affairs (OCHA) to continue implementing its response activities in the region. It is important to note that the acquired loan needs to be reimbursed through donor contributions. The table below details the contributions received, by donor:
Table 1: SOUTHERN AFRICA CRISIS: FUNDS RECEIVED BY DONOR
AS OF 22 OCTOBER 2002
|Malawi, Zambia, Regional unit|
|German National Committee||
|Mozambique, Zimbabwe, Lesotho, Swaziland|
|Malawi, Zimbabwe, Zambia|
|Malawi, Mozambique, Zimbabwe, Zambia, Regional unit|
|UK National Committee||
|Finnish National Committee||
|Spanish National Committee||
Further details of the southern Africa emergency programme can be obtained from:
Office of Emergency Programmes
Tel: + 41 22 909 5546
Fax: + 41 22 909 5902
Tel: + 1 212 326 7009
Fax: + 1 212 326 7165